Soluble Vascular Cell Adhesion Molecule as a Predictor of Arteriovenous Fistula Maturation: A Pilot Study
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Abstract
Background: Predicting arteriovenous fistula (AVF) maturation in patients with end-stage kidney disease remains challenging. Soluble vascular cell adhesion molecule (sVCAM) is involved in vascular remodeling, but its predictive value is not well established. This study evaluated whether sVCAM levels can predict AVF maturation 8 weeks after creation.
Methods: In this prospective pilot diagnostic study, 19 patients undergoing AVF creation were enrolled. sVCAM levels were measured preoperatively and 4 weeks postoperatively. AVF maturation was assessed at 8 weeks using ultrasonographic criteria.
Results: Twelve patients (63%) achieved AVF maturation. Those with mature AVFs had significantly higher baseline sVCAM levels than those without maturation (1505.9±383.1 vs. 1029.9±378.3 ng/mL, p = 0.018). The percentage change in sVCAM levels also differed significantly between groups (mature: –6.6±35.8% vs. non-mature: +19.4±10.8%, p = 0.035). A baseline sVCAM threshold of ≥985.9 ng/mL yielded 100% sensitivity and 71.4% specificity for predicting AVF maturation (AUC = 0.845, 95% CI: 0.632–1.000). Combining sVCAM levels with clinical parameters, including age <73 years and BMI <30 kg/m², further improved predictive accuracy, achieving the highest AUC of 0.935 (95% CI: 0.804–1.000).
Conclusions: Preoperative sVCAM level is a promising biomarker for predicting successful AVF maturation. Incorporating clinical parameters alongside sVCAM further enhances predictive performance.
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